"The business of insurance is regulated principally
by the states. Each state has an insurance official who is charged
with overseeing the solvency of insurance companies doing business
in the state as well as their rates and market practices. Insurance
regulation has been subject to increasing external and internal
forces in recent years which have forced the states to respond.
Fundamental changes in the structure and performance of the insurance
industry have complicated regulators' jobs. Competitive pressures
have caused insurers to assume greater risk in order to offer more
attractive prices and products to consumers, resulting in larger
and more frequent insurer failures. Insurance markets have increasingly
become national and international in scope as insurers have widened
the boundaries of their operations. High costs in some lines of
insurance and natural disasters have intensified political pressure
to constrain insurance prices and maintain availability of coverage.
The increase in insurer failures and other market problems have
raised serious concerns about whether state insurance regulation
is adequate to protect consumers. Congressional investigators have
questioned whether the states are able to effectively regulate a
diverse and global insurance industry (GAO, 1989 and 1991). A report
issued by the House Energy and Commerce Committee in 1990, then
chaired by Rep. John Dingell (D-MI), criticized state insurance
regulators for: lacking adequate resources; using unreliable financial
information; failing to coordinate; and performing infrequent and
poorly prioritized examinations (Failed Promises, 1990). Various
proposals have been offered to impose a greater federal role in
areas such as solvency, health insurance, property insurance underwriting
and catastrophe insurance. This recent activity is only the latest
chapter in a long history of federal-state clashes over the regulation
of the insurance industry.
These forces have had a considerable effect on insurance regulatory
institutions. Some legislators and insurance commissioners, cognizant
of the shortcomings of the insurance regulatory system, initiated
a number of significant reforms before critics of the system became
aware of the problems. Over the last decade, the states have engaged
in an unprecedented program to rebuild the framework for insurance
regulation. The lion's share of this effort has been involved in
strengthening solvency regulation by establishing more stringent
capital standards, expanding financial reporting, improving monitoring
tools, and certifying insurance departments. Other initiatives are
underway to improve the efficiency of agent licensing and the regulation
of rates and policy forms and to expand consumer protections against
market abuses. State insurance departments have greatly increased
their resources in terms of both people and technology to support
these efforts." Insurance Regulation in Transition
|
Adolescent
Confidentiality and privacy Under HIPAA |
Adolescents
are more likely than adults to have their state-protected right
to medical confidentiality violated by providers or insurers |
281 kb pdf |
|
An Introduction to Diagnosis-based
risk adjusters
|
Report for Adjusters for insurance companies
|
363 kb pdf
|
|
Catholic
Health Association of Canada
Calls on Government to Compensate
All Who Contracted Hepatitis C from Tainted Blood
|
The
CHAC, in union with many other Canadians, strongly urges the
federal government to initiate action, with the provincial
governments, to provide just, compassionate and prompt
compensation for all people who have contracted hepatitis C
from tainted blood because of the failure of government to
adequately regulate blood safety
|
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Claims Against Insurance Companies for Fraud & Bad Faith |
Insurance
companies nationwide have begun using claims handling
practices that are aimed at cost containment and building
claims profit. This means the insurance companies design
practices aimed at delaying the payment of claims and
underpaying the fair claim value of a given claim. This is
not an ethical practice and violates all insurance industry
customs and ethical principles of the insurance industry. |
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COBRA:
Extending Your Employer-Based Health Insurance
|
COBRA
is a federal law that requires employers to allow employees
and dependents losing health insurance to stay on the
employer’s plan
|
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Congressional members with ties to Pharm. companies
|
The pharmaceutical industry is the most powerful
special interest in Washington. They not only have the money
to hire
300 lobbyists on Capitol Hill, contribute $9 million to both
political parties and spend tens of millions on advertising,
but they
have been also to put a number of former FDA commissioners on
their payroll |
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Delays, Denials & Deceptions-The truth about LTD insurance
|
Claimants
who succeed in the battle for benefits tend to be savvy,
articulate and persistent individuals with the resources to
obtain sophisticated medical evidence and aggressive
attorneys. Poorer, older, less-educated and extremely ill
claimants seldom fare as well. The sickest and least
privileged among us may be easily brought down by insurance
company employees who find them fair game for harassment,
deception and intimidation. |
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Direct
cost of follow-up for Percutaneous and Mucocutaneous Exposures
to At risk Body Fluids
|
Report
by the International Health Care Worker Safety Center
|
48 kb pdf
|
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Directions in HIV Service Deliver & Care for People with
HIV/AIDS-The Role of Legal Services
|
In this
report, we first describe the methods used to gather
information about the legal needs of people with HIV/AIDS and
the legal services available to them. In the findings
section, we share what we found out about how legal services
help HIV/AIDS clients access and maintain health care. We
look in detail at how legal services help people with HIV/AIDS
overcome barriers that directly impede their access to health
care. And we explore the ways that HIV/AIDS-related legal
services help clients to meet subsistence needs, thereby
keeping them fed, clothed, and housed prerequisites of good
health.
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Disability
Income-Insurance Report
|
Risk
Insights-Magazine Articles: Group long-term disability
Insurance, Expands Educational program and Training location,
Financial Performance of Disability, Disability, Case
Management, Income Protection
|
751 kb pdf
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Employer & Union Plan Sponsors: BENEFICIARIES WHO WILL BE
AUTOMATICALLY ENROLLED IN A MEDICARE DRUG PLAN AND HOW THEIR
RETIREE COVERAGE WILL BE AFFECTED |
These
individuals may have to choose between remaining enrolled in
a Medicare drug plan and losing their (and their spouse’s
and dependent’s) employer/union coverage, or keeping their
employer/union retiree coverage and opting out of the
Medicare drug plan in which they were automatically enrolled
even though the Medicare drug plan provides comprehensive
drug coverage at minimal cost. |
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ERISA Disability Litigation How To Sue Your LTD Insurance
Carrier In United States Federal Court Without an Attorney |
This
report is oriented to those persons who are disabled by
Chronic Fatigue and Immune Dysfunction Syndrome (a.k.a. CFIDS,
CFS, M.E.) and other so called "self-reported conditions" such
as Fibromyalgia Syndrome (FMS) and Multiple Chemical
Sensitivity (MCS) who must sue to recover long term disability
benefits from employee benefit plan providers (insurance
companies). |
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Financial
and Risk considerations for successful disease management
programs
|
Report
for insurance industry
|
211 kb pdf
|
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General
Rules About Patient Confidentiality
|
This from perspective of an injured workers'
advocate: The confidentiality issue is generally
state-law specific, either in the state's WC law itself or
other legislation/common law precedent regarding patient
privacy. In our State (NC), WC law provides that the
employer or its carrier, usually, is entitled to clinic notes,
lab data, from MD treating the work-related injury if it/they
are paying compensation, including medical, to the IW.
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Hepatitis C Virus
report for insurance companies
|
Healthcare
workers, public safety workers, and law enforcement workers
deserve and should demand protection from exposure to Hepatitis C Virus
|
417 kb pdf
|
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Healthcare
Cost of Hepatitis C-infected Members in a Managed Care
Organization
|
There
was a significant patient outlier that had total medical costs
of $881.933. The majority of these costs were related to
home care.
|
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HIPPA
Nondiscrimination Requirements
|
Summary
of the HIPPA law
|
50 kb pdf
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HIV
Testing and Confidentiality: Final Report
|
In
Canada, AIDS was treated as notifiable in British Columbia
beginning in 1983 under a provincial regulation requiring
physicians to report a communicable disease "which
becomes epidemic or shows unusual features."1112 AIDS and
sometimes HIV was subsequently made notifiable or reportable
by legislative amendment in all provinces and territories.
Some provinces and territories require nominal reporting of
AIDS and sometimes even HIV, while in the others reporting is
non-nominal
|
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Insurance
claims-1998 Legislative Outlook
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Current
Issues in Employee Benefits
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151 kb pdf
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Insurance
company-tracking claimants
|
Web
site for this company and the benefits that it provides the
insurance industry
|
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Insurance
Privacy Rules
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Report
for insurance industry on GATT Benefits
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336 kb pdf
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Legislative Survey of State Confidentiality Laws, with Specific
Emphasis on HIV and Immunization |
This report
examines current state and federal law protecting the
confidentiality of health information. It focuses on four
specific areas: public health information held by government,
privately held health care information, HIV and AIDS-related
information, and immunization information.
The ways in which our modern medical and public health systems
collect, store, and use personally identifiable information have
increased both the potential benefits from access to such
information and the possible harms from improper uses and
disclosures. The report examines the importance of both the
collection of health information and the protection of its
privacy. The collection and use of health information involves
two important goals |
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Medical
Malpractice |
THE
PROFESSIONAL-PATIENT RELATIONSHIP (it is a question of law
that the court will have to decide early in the case) The
threshold question is whether the doctor had a relationship
with the patient sufficient to create a duty. A physician
relationship is usually a prerequisite to a professional
malpractice suit against a doctor. Insurance coverage
examination usually creates no duty. Workplace examinations
may give rise to a P/P relationship. |
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Mental
Illness-Disability insurance Claims |
Not only are
mental illness disability claims expensive and complex; they can
also take years to resolve. In this environment of ever
increasing mental illness diagnoses, only those with a complete
understanding of current treatment protocols, the most recent
cases and the latest rehab strategies for getting mental illness
claimants back to work will be positioned to lower the payment
costs and litigation risks of these claims |
267 kb pdf |
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Mix-up breaches confidentiality of dozens in state AIDS
program |
The state
Department of Health Services inadvertently revealed the
names and addresses of up to 53 Californians enrolled in an
AIDS drug assistance program to other enrollees by putting
benefit notification letters in the wrong envelopes,
officials said Friday. |
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National
Health Interview Survey (NHIS)
|
NHIS
survey
|
178 kb pdf
|
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Perspective-magazine:
health care fraud
|
Mid-way
through article: Corporate Healthcare Fraud
|
346 kb pdf
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Proposed Rules Revising Medical Criteria for Evaluating
Immune System Disorders |
Pre-test
Public Health Counseling vs. Informed Consent Law—View from
the AIDS Coordinating Committee |
Pdf 152 |
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Provider
Excess Insurance
|
Report
for the insurance industry
|
462 kb pdf
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Release of Behavioral Health, Developmental Disabilities, HIV,
and Substance Abuse Information: Guidelines for Legal
Compliance |
Hospital,
physician practices, and other health care facilities are
repositories for much medical information. Safeguarding the
confidentiality of such information is a significant issue for
any hospital or other health care entity that keeps patient
medical records to maintain patient confidence and to avoid
liability. Because damages could ensue should inappropriate
disclosure occur, patient records containing behavioral
health, developmental disabilities, HIV, and substance abuse
information must be handled with special attention, in
accordance with state and federal laws, rules, and
regulations. Individuals involved in health information
management should be well-informed about patient
confidentiality requirements overall and should also track
these areas carefully to develop and implement appropriate
policies and procedures governing the release of patient
information |
50 kb pdf |
|
Risk
and Management of Blood-Borne Infections in Health Care
Workers
|
Report
in ‘Clinical Microbiology Review"
|
354 kb pdf
|
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Structural
Change & Regulatory Response in the Insurance Industry
|
The
business of insurance is regulated principally by the states.
Each state has an insurance official who is charged with
overseeing the solvency of insurance companies doing business
in the state as well as their rates and market practices.
Insurance regulation has been subject to increasing external
and internal forces in recent years which have forced the
states to respond. Fundamental changes in the structure and
performance of the insurance industry have complicated
regulators' jobs.
|
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|
Subjective Symptom Disability Claims-CFS, FMS, and MCSS |
We do warn
readers, however, that calling Chronic Fatigue Syndrome,
Fibromyalgia, and Multiple Chemical Sensitivity Syndrome
"subjective symptom disabilities" can be a bit misleading --
as Altzheimer's Syndrome can be diagnosed without having to
perform a brain autopsy, these serious (and overlapping)
physical conditions are in no way "subjective" themselves
(that is, all in the experience of the patient) -- all three
produce verifiable physical symptoms that can be recognized by
a physician with up-to-date information about these disease
syndromes. However, there are no objective tests approved by
the CDC or the FDA as "proof" that a patient has any one (or
more) of these three disease syndromes. That is not quite the
same thing as saying the symptoms are entirely subjective, and
the reader must take care not to form the impression that
these diseases are diagnosed by patient self-description
alone: they are not. To repeat: the problem is that there is
no "marker" (such as deterioration of the myelin sheath that
appears in the spinal fluid of an M.S. patient) that can
"prove" definitively whether or not a patient has CFS, or FMS,
or MCSS. The insurance companies are saying, in effect, that
until such a marker is found, patients who are sufficiently
unfortunate to suffer from these diseases are not insured
under regular policies. |
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Tampering
With Prescription Drugs?
|
Some
prescription drugs are tampered with as they pass through
several middlemen on their way to the local pharmacy, reports 60
Minutes correspondent Bob Simon. What’s more, if the
drugs’ manufacturers find out, they are not required to tell
patients or the FDA that the drugs could be dangerous.
|
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|
The
Hepatitis C Epidemic: Looking at the tip of the Iceberg
|
Report
for insurance industry on Hepatitis C Virus
|
445 kb pdf
|
|
The
Hepatitis C Epidemic:
A Significant Risk for Workers’ Compensation
|
The
Hepatitis C Virus epidemic brings large risks to workers’ compensation
programs and requires new risk management techniques. The
workers’ compensation industry has generally not recognized
these risks, although it is becoming aware of the new
challenges that the Hepatitis C Virus epidemic brings. There is much
uncertainty about employers’ and insurers’ liabilities for
Hepatitis C Virus-infected workers. The authors intend that, by presenting
the results of our actuarial analysis, this report will help
define the issues and that our recommendations will reduce the
industry’s long-term financial exposure.
|
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|
The Myth of Workers' Compensation Fraud |
In recent
years, the insurance industry's focus on cheaters and
malingerers helped push through national workers' compensation
reform, a profitable cost-cutting campaign supported by
outrage over alleged abuse of the system. The problem,
however, is that the fraud image is false for the vast
majority of workers' compensation cases. Studies show that
only 1 to 2 percent of workers' compensation claims are
fraudulent. Certainly, the tens of thousands of workers killed
every year were hardly aiming for a free ride on their
employer's tab. |
|
|
The
Other Drug War
|
Pharmaceuticals’
625 Washington Lobbyists
|
318 kb pdf
|
|
Winning
Affordable Medications for all Americans
|
Testimony
of Alan Sager
|
27 kb pdf
|
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